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Preface The aim of this Ph.D. thesis is to make a contribution to the promotion of healthy eating in the worksite setting. The thesis is completed in co-operation with the Department of Management Engineering (MAN), Section of Innovation and Sustainability and the Department of Nutrition (FOOD), National Food Institute, Technical University of Denmark.

The foundation of this thesis is nutrition, since my educational background is in food science.

Furthermore I have an interest in social psychology, sociology and food sociology that I studied in US at the Culinary Institute of America and at Dutchess County Community College in Poughkeepsie, NY.

Through the years I have been working with interventions aiming at promoting healthy eating at worksite canteens and I have noticed that the availability of healthy food is of great importance to health promotion. I have also noticed that the meals available in worksite canteens are not always healthy compared to the nutritional recommendations. I found that the canteen managers and staff at the canteens are experts, not only in preparing the meals but also in knowing the social context of the canteen in relation to the worksite. They are important stakeholders in any health promotion intervention regarding the canteen and in order to sustain the intervention the canteen manager‟s commitment to change is crucial.

It is my impression that the sustainability of an intervention is often talked about but not often studied. As I previously (from 2000-2002) worked with the promotion of healthy meals in Danish worksite canteens, it made sense for me to return to these canteens to study the mechanisms of sustainability. The idea was to study the 5 year sustainability of a 6 month fruit and vegetables (F&V) intervention in five Danish worksite canteens in order to build up more scientific evidence about planning and embedding of healthier worksite eating. The current thesis presents the outcome of this work.

It is my idea and hope that the combination and presentation of my research will provide the reader with the best possible understanding of the diverse aspects of the sustainability of an intervention.

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Acknowledgements I am so grateful to many people for supporting me through this Ph.D. study.

I would especially like to thank my main supervisor Michael Søgaard Jørgensen (MAN, DTU) for being very supportive and enthusiastic about the study. From him I learned always to be modest in my research and towards the people with whom I work. I also want to thank my other advisor Bent Egberg Mikkelsen (Nutrition and Public Food Systems, Aalborg University, former FOOD, DTU) for his support. Their competences lie at the interdisciplinary research combining several areas from food science and environmental science to action research, user innovation and participatory approach The staff and the canteens managers at the five worksite canteens are sincerely thanked for being cooperative and patient towards the project and my research through the last 10 years since the „„6 a day‟ -project started in 2000.

My colleges at MAN are thanked for having me around and a special thank to the head of MAN, professor Per Langaa Jensen for having confidence in me. Mette Weinreich Hansen is thanked for good discussions and for reviewing Paper 3 and Mirjam Godskesen (MAN) is thanked for coaching me through changing times. Also the MEAL element group (FOOD, MAN) is thanked for numerous and inspiring meetings during the years.

From FOOD my very good colleague Anne Dahl Lassen is thanked for her never ending support in my research. She has a great knowledge in this area and has been of great inspiration.

The head of the FOOD department Inge Tetens has been very supportive and my colleges Anja Biltoft-Jensen, Anne Marie Bech, Camilla Hoppe, Ellen Trolle, Margit Groth, Sisse Fagt from FOOD all did contribute to my research and kept me on track. A special thank to Annelise Christensen who helped me set up the thesis and to Volodja Epremian for keeping track on the references.

I would also thank Jens S Andersen and Ole Hels both from FOOD that performed the statistical analysis in Paper 1 and Paper 2.

I have enjoyed many good discussions about the project during the writing of my thesis with Eva Høy Engelund and Ida Husby. Also a special thank to Liselotte Schäfer Elinder and Vibeke Bagger for reviewing my thesis.

My very good friend Elizabeth Shieh has been a very patient reader editing my three papers and this thesis and also kept my spirit high and encouraged me to finish my Ph.D.

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At last I would like to thank my family, friends and my three children, Christian, Oscar and Victoria for being supportive and around me during this tough period of my life. Finally Thomas is thanked for his support and love.

Holte, April 2010 Anne Vibeke Thorsen This Ph.D. thesis has been carried out during my employment at the Department of Nutrition, the Technical University. It is part of the project “Meal elements optimizing the quality of distributed meals” a co-operation between the Department of Management Engineering, the Division of Nutrition, National Food Institute, and the Food Production Engineering (former BioCentrum-DTU), all at Technical University of Denmark. The work was financially supported by The Directorate for Food, Fisheries and Agro-Business and by the Department of Management Engineering and the Division of Nutrition, National Food Institute at Technical University of Denmark.

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